Back pain
Back pain is the most common musculoskeletal (MSK) condition. The health profile for England reports that low back and neck pain remains the biggest cause of ill health overall and across all age groups. Back pain is one of the most common reasons people see a doctor or miss days at work; it is reported that each year, 20% of the population consult their GP about a MSK problem. Most people will experience one or more episodes of back pain during their lives. In many cases, it starts suddenly and gets better quickly, without the need for any treatment.
However, back pain can be painful, debilitating and persistent, and some people suffer repeated episodes. It can also be associated with other symptoms, such as leg pain or sciatica. It may start following a specific incident, or it can develop gradually and progressively get worse.
What are the types of back pain?
There are many different types of back pain with different causes. The key to getting the right treatment is to establish which type you may have and when to seek advice, particularly if your back pain is not improving.
Your spine is one of the strongest parts of your body. It is made of solid blocks of bone called vertebrae, joined together by softer pads called discs, which act as shock absorbers and maintain flexibility. Your back is reinforced by strong ligaments, surrounded by powerful muscles for support. It is, in fact, surprisingly difficult to damage your spine.
The majority of people with back pain are suffering from what is known as 'simple' or 'mechanical' back pain. This means that the pain is unrelated to any serious underlying condition and there are no trapped or compressed nerves. We do not always know the exact tissues involved in mechanical back pain. Muscles, joints and ligaments can all be involved. Mechanical back pain can be caused by poor posture, prolonged sitting in an uncomfortable position, and even muscular tension due to emotional or work-related stress.
Age can also contribute to back pain. The shock-absorbing pads or discs between the bones of the back can narrow with age, and this can cause stiffness and pain and make it difficult to move.
Mechanical back pain is relatively common. Less frequently, the nerves of the back can sometimes become irritated, compressed, or trapped. Again, there can be many reasons why this happens, but slipped discs or age-related changes to the spine can lead to pain spreading down the leg, which is commonly referred to as sciatica. This can be accompanied by pins and needles, tingling, numbness, and weakness in all or part of the leg and foot.
Back pain can happen suddenly or gradually build in intensity. It is classed as acute back pain if it lasts for a few days to a few weeks. If your pain lasts over 12 weeks and occurs daily, it is classified as chronic back pain.
Why do people get back pain?
People experience back pain for all sorts of reasons. There are many triggers for an episode of back pain, but there is often no obvious reason why it develops.
There are several factors that can increase your risk of developing back pain, which include:
- Your Fitness Level: back pain can result from not moving your body enough or by moving too much, too quickly, and overdoing it. The more consistently we move, the fitter we are and the less likely we are to have back pain.
- Your Job: jobs requiring repetitive movements and heavy lifting increase our risk, though desk-based jobs can still result in back pain if there is insufficient movement throughout the day or poor posture.
- Your Stress Levels: Worry, stress or anxiety can cause tension in the back muscles or delay recovery of existing back pain.
- Previous Injuries: Sometimes, an old injury or a flare-up of an existing injury might also cause problems.
Although it can be very painful, back pain rarely has a serious underlying cause. Seeking care from a qualified health professional, such as a chiropractor, can help treat back pain. Chiropractors are experienced in diagnosing conditions of the back and spine and can identify whether a referral or specialist investigations are needed.
Symptoms of back pain
Back pain can be very uncomfortable, as the tissues and structures of the back are highly sensitive to pain.
Back pain can be focused in one specific spot, on either side of the back, or it can be more generalised, spreading over the back and buttocks. In some cases, the pain can also radiate into the legs and sometimes into the feet.
It can be a sharp or dull pain, though the intensity varies for everyone. The pain can be constant, though, for some people, it can also come and go. You may also experience pain with certain movements, like bending or getting out of a chair.
If the pain does not go after a few days or starts to get worse, it is worth seeking professional advice. Early treatment will help you get better faster.
How can I manage my back pain?
About half of people who have an episode of back pain will have another episode within a couple of years, but that still doesn't mean that it is necessarily serious. Most people return to normal activities between episodes within two or three weeks, with few remaining symptoms.
To help speed up your recovery, you can do the following:
Keep moving and stay as active as possible. If movement is initially a struggle, gradually increase your daily movement within your tolerance level.
- Take frequent breaks from sitting or standing in the same position.
- Avoid spending long periods lying down. Bed rest is no longer recommended for back pain.
- Sleep with a pillow between your knees if you're a side sleeper or under your knees if you lie on your back.
- Use an ice pack, such as a bag of frozen peas, wrapped in a tea towel to reduce pain and swelling.
- Use a heat pack, like a hot water bottle wrapped in a tea towel, to relieve joint stiffness or muscle spasms.
- Avoid repetitive movements or heavy lifting as this can place more strain on your back while you're recovering.
If your back pain does not improve, it is important to seek help. Early treatment will get you better faster.
How can a chiropractor help with my back pain?
Chiropractors specialise in assessing, diagnosing, and managing mechanical disorders of the MSK system. They are highly trained in finding the cause of spine pain. In the UK, they undergo a minimum of four years of full-time training. Importantly, chiropractors are regulated by law and must work within strict professional and ethical boundaries.
You can visit a chiropractor at any time, either the day after the pain starts after you've been managing the symptoms for a long period, or even preventatively. You do not need a referral from your GP to receive chiropractic care.
Before starting treatment, a chiropractor will do a full assessment. This will involve taking details about your condition, current health and medical history and performing a physical examination. They may refer you for additional tests, such as X-rays, MRI scans or blood tests if necessary. It is important for your chiropractor to gather as much information about your back pain as possible so that the most precise diagnosis can be made.
Your chiropractor will then explain what is wrong, what can be done and what you can expect from chiropractic treatment.
Treatment options
After you have had an assessment with a chiropractor and agreed on their proposed plan of management, treatment can begin.
Chiropractors are best known for manual treatments such as spinal manipulation, using their hands to relieve stiff or restricted joints, and mobilisation, which gradually moves joints. However, this is only part of their overall care approach.
Chiropractors may also use other recommended treatments, such as massage, and provide specific exercises to stretch, mobilise, and strengthen your back. Your chiropractor may also offer lifestyle advice to help recovery and prevent repeated episodes of back pain. This is in line with the National Institute of Clinical Excellence (NICE) guidelines for the management of back pain.
If your chiropractor does not think chiropractic treatment will benefit you, they may refer you to your GP or another health professional. As chiropractors do not prescribe pain medication, you may be referred to your GP if they think this would help you. Sometimes, your chiropractor may send a brief report and summary of your care to your GP to ensure you receive a joined-up approach to care.
Many people who suffer long-term/chronic back pain benefit from regular, supportive chiropractic care to help manage their symptoms and reduce the risk of recurrent episodes.
When to seek medical attention?
There are some instances when medical attention is required.
Seek medical attention by seeing your GP or calling 111 if you have back pain and experience any of the following:
- A high temperature
- You've lost weight without trying to
- There's a lump or swelling in your back or your back has changed shape
- The pain does not improve after resting or is worse at night
- The pain is made worse when sneezing, coughing or pooing
- The pain is coming from the top of your back (between your shoulders) rather than your lower back
- The pain has not improved after a few weeks.
- Your back pain was a result of significant trauma, such as a fall from a height.
Seek URGENT medical attention by calling 999 or going to A&E if you have back pain and experience any of the following:
- Pain, tingling, weakness or numbness in both legs
- Numbness or tingling around your genitals or buttocks
- Altered feeling when using toilet paper to wipe yourself
- Difficulty urinating
- Loss of bladder or bowel control (peeing or pooing yourself)
- Chest pain
- Your back pain was a result of significant trauma, such as a fall from a height.
References:
Ly, M., Fitzpatrick, J., Ellis , B. and Loftis, T. (2019). Why are musculoskeletal conditions the biggest contributor to morbidity? - UK Health Security Agency. [online] ukhsa.blog.gov.uk. Available at:
NICE (2016). Recommendations | Low back pain and sciatica in over 16s: assessment and management | Guidance | NICE. [online] Nice.org.uk. Available at:
Nancy Garrick, D.D. (2017). Back Pain. [online] National Institute of Arthritis and Musculoskeletal and Skin Diseases. Available at: .